The utility of performing 18.FDG PET/CT in the tumor staging and as a clinical management tool in the post-12Th-week chemoradiotherapy (CRT) in patients (pts) harboring locally advanced squamous-cell carcinoima of head and neck (LASCCHN) has been established. The aim of this report is to evaluate the impact of incorporating a staging 18.FDG-PET/CT and post CRT, for pts harboring 7Thedition AJCC staged III-IVA/B treated in a single medical centre.
Patients harboring LASCCHN who underwent induction chemotherapy (IC) with triplet taxane-containing regimen followed by concurrent CRT were prospectively evaluated as part of the A.C. Camargo Cancer Center PET/CT trial. Our pts underwent three 18.FDG-PET/CT. First as a baseline, second after cycle-1 IC and third at 10 to 12 weeks after completion of CRT. Our primary objective was early 18.FDG-PET/CT tumor response assessment after cycle-1 IC, which has been reported elsewhere. Herein we report changes in clinical staging, radiotherapy and surgical management generated by baseline and post-therapy PET-CTs. All pts provided signed consent for trial participation.
Between February 2010 and July 2013, 49 pts (41 oropharynx, 4 hypopharynx and 4 larynx) were recruited. Upstaging in neck lymph nodes were registered in 6 cases (12.2%): N0 to N1 in 2, N1 to N2b in 1, N1 to N2c in 1, N2a to N2c in 1, N2b to N2c in one. One patient harboring unilateral N3 had demonstrated bilateral lymph node disease. Downstaging N1 to N0 was registered in 2 pts. Suspected distant metastatic disease was registered in 2 cases (lung 1, bone 1). Primary occult tumor was identified in 3, and secondary synchronic colorectal tumor was diagnosed in one case. Radiotherapy planning changes were generated by detection of new regional metastatic lymph nodes or identification of primary tumor in 10 patients (20.4%). Post-radiotherapy 18.FDG PET/CT was able to detect residual lymph node disease and residual primary disease in 3 and 1 pts respectively.
These findings confirm the clinical utility of performing pre and post CRT 18.FDG PET/CT in pts harboring LASCCHN.
Clinical trial identification
Brazilian Clinical Trial Registry - ReBEC - RBR-9wwstd.
Legal entity responsible for the study
A.C. Camargo Cancer Center.
Has not received any funding.
All authors have declared no conflicts of interest.